Astrocytoma surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Indications

• Surgical intervention is the mainstay of treatment for astrocytomas.

• Some studies suggest the resection of big tumors which are symptomatic or cause intracranial hypertension and monitor the small ones for further growth.

• Other Studies proved that early resection of the tumor at the time of diagnosis can improve patients prognosis.(3-8 management of low grade)

Surgery

Low grade astrocytoma

• Extensive resection is preferred over partial resection or biopsy.
• Some types of diffuse astrocytomas which are IDH mutation positive are prone to growth back if small areas of tumor cell remain after surgery.
• Because of infiltrative character of astrocytomas, complete resection may not be possible so we need chemotherapy or radiation for complete treatment.(5_9101112 management of low grade)

High grade astrocytoma

• The main goal in resection of high-grade astrocytoma is to resect all of the tumor and involved brain tissue with minimal neurological damage.
• Many studies demonstrated that extensive resection improves patient’s prognosis.
• In high grade astrocytomas which complete resection is not possible, the preferred areas for resection are contrast enhancing parts of the tumor.(14_29_30 _44_45 clinical and... highgrade)

Contraindications

The relative contraindications of brain surgery are:

• Advanced age
• Sever cardiopulmonary dysfunction
• Inaccessible lesions
• Sever systemic illness such as sepsis.(med 2 3)